Health on the Horizon

This week I had the pleasure of speaking at the Premier’s Summit on Healthcare in Newfoundland and Labrador. Flying from Saskatoon to St. John’s in the winter is no mean feat, and a series of delays and cancelled flights meant I had a lot of time to reflect en route.

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I was struck by the similarities that exist between the Rock and my prairie home. I grew up near Moose Jaw; in Newfoundland they’ve got the town of Cow Head. There’s Love, SK, and Heart’s Desire, NL, and it’s hard to ignore the connection between Climax and Conception Bay. It goes beyond the love of odd place names of course. Both are places of the horizon; I remember watching storms approach the farm for hours just as you might at sea. They’ve also been sources of diaspora. For a long time if you lived in Ontario, BC or Alberta, chances are you knew people from NL or SK, but you’d probably never been to either place.

Photo by Pam Morris

The two provinces have been have-nots, are now haves, and with the current economic climate face the prospect of being have-nots once again. The past periods of poverty relative to the rest of the country manifest themselves in the health of the two provinces as well, with high rates of obesity, tobacco and alcohol use, chronic mental and physical illness.

The past periods of poverty relative to the rest of the country manifest themselves in the health of the two provinces as well, with high rates of obesity, tobacco and alcohol use, chronic mental and physical illness

Neither province has a lot of people, there's just over a million in Saskatchewan and half that number in Newfoundland and Labrador. As a result there are significant geographical and financial challenges in providing health care to a population with a higher burden of illness. However, the smaller size also offers some advantages. I often joke that Saskatchewan is a pilot province, a place small enough to experiment with innovative policy changes, and large enough for them to matter. It’s not difficult for someone who wants to make change to connect with those in a position to do so. Newfoundland and Labrador has a similar reality, and with 250 plus people in a room to discuss the future of health in the province, the summit offered a real opportunity for positive change.

With that in mind I offered a couple of specific challenges to the people in the room. The first was to remember the primary role that the social determinants of health – factors like income, education, employment, housing, nutrition and the wider environment – play in determining health outcomes. The second was to consider how that idea could inform not only health policy, but also policy in all areas of government.

A Health in All Policies approach is the most impactful way for governments to start thinking and acting upstream to create the conditions for better health

This was perhaps a provocative message to deliver to a group focused on primary health care reform, but I was emboldened by the invitation from Minister of Health Stephen Kent. When running for leader of the Progressive Conservatives, he became one of the first politicians in English-speaking Canada to advocate for a Health in All Policies approach that looks at all government decisions through a health lens. This is the most impactful way for governments to start thinking and acting upstream to create the conditions for better health, and it was very encouraging to have political leadership as well as healthcare professionals, government staff, representatives of community agencies and patient advocates respond positively to the message.

Newfoundland and Labrador is a province well-positioned to demonstrate leadership in this area. Their Poverty Reduction Strategy has been one of the nation’s most successful, and they’ve invested significantly in improving access to housing, early childhood education and post-secondary education. The challenge will be to maintain that focus through more difficult economic times, when investment in people to maintain health is more important than ever.

Want to keep reading?

Staying Close to the Source - by Ryan Meili. Reflections on Upstream's first year and how being embedded locally keeps us grounded in the stories that illustrate the impact of the social determinants of health.

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This is such important and tremendous work that you are doing! I hope that the provinces that are taking initiative can push for federal support as well. If all three levels of government and all four parties can find a way to see the true costs of poverty, then solving these issues can be a reality through a proposal such as GAI. This may not solve everything, but we need to start somewhere. I carry this dream close to my heart for all Canadians. It is not only the economically “right” thing to do, but the morally “right” thing to do. Thank you truly for what you and others on this path are doing.